When one has solitude and time to reflect and think, a problem can arise.

BY: Dr Mok Yee Ming

Singaporeans are known for several things, but we are particularly known for our passion in shopping and food, and that has been sufficient in filling the lives and thoughts of many Singaporeans. For many years, life was about going to work, eating with friends or “makan kakis”, ta bao (Chinese word for takeout) food for dinner or eat out, and then we would repeat the whole process each week. Maybe on the weekends we would go shopping or just “jalan jalan” (Malay word for going for a walk).

But we are now living in unprecedented times with this global pandemic that has forced us to change our lifestyles as well as the way we live. This has never happened in the history of Singapore before. During the circuit breaker, schools and shops were closed, social interactions were discouraged and we had to work from home. Entire families and individuals had to isolate at home.

This can be extremely difficult as not everyone likes or gets along with who they are staying with, which in itself can cause much stress. Furthermore, there is no perceivable change with the passing of the days or even the hours. So, what previously was precious and appreciated (e.g. time with family), can become a chore. Even now, in the post circuit-breaker phase, gatherings are still discouraged and the seniors are encouraged to minimise their exposure and isolate as much as possible.

During pre-COVID, many could and did go through life focusing on the material and external, now with the enforced solitude and slower pace of life, we are made to confront ourselves. For many, this can be a good thing – you have time to breath, smell the roses, and appreciate the things about yourself and of the people around you. Cycling, walking and jogging has become a national pastime. Everyone is eating more healthily, leading to periods of flour shortages, and other assorted baking and cooking items.

 

What can go wrong?

However, for some this solitude and time to reflect and think can be a problem. Feeling alone can be surprisingly common. For some, being in groups provides a sense of belonging. With this solitude, you tend to self-reflect and acknowledge your choices in life, or face up to recurrent fears and thoughts. For some, when the distractions are no longer there, they have to cope with their mental health issues which had been kept at bay.

So, what are some of these issues?

1. Cabin fever – This refers to the distressing claustrophobic irritability or restlessness experienced when a person, or group, is stuck at an isolated location or in confined quarters for an extended period of time. It is a description and not a diagnosis or illness, but “cabin fever” can lead to irrational decisions or trigger conflicts or relapse of psychiatric disorders.
2. Anxiety – This is a common emotion. We experience anxiety in many situations. Feeling anxious may even be beneficial as it forces us to prepare for things such as exams and performances. However, feelings of anxiety may be accentuated and worsen during this period of uncertainty and change. It can be debilitating. People with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger, and can last a long time.
3. Depression – This is another common emotion. All of us feel depressed or down at times, but it is in response to an event and transient. During this period, with dealing with losses, changes in role and environment, it is natural to feel down. It can be prolonged as the pandemic drags on, leading to problems coping. For those already suffering from a depressive illness, their illness may be triggered or exacerbated.

Living in an Asian culture, it can be difficult for the seniors to articulate their emotions. At time, seniors may complain to others of increased physical aches and pains. At times, even to themselves, they just justify their feelings as that of “growing old”. It is most definitely not.

 

Can all this be prevented?

Yes, there are things to do to help prevent and even alleviate such symptoms:

1. Learn to be kind to yourself – This is an extremely out of the ordinary situation. You are not alone in feeling the way you do and you are not alone in having difficulties adjusting. Accept that you will have difficulties adjusting and give yourself time.
2. Reach out – Yes, we should minimise our interactions with others. We should avoid going out to crowded areas and we still are not able to attend gatherings. But there are other ways even if electronic means are difficult. An old fashion phone call or handwritten letter can still bridge that gap of isolation and loneliness.
3. Live well – It is impossible to separate the body and mind. Having a healthy body helps with a healthy mind. Make sure you maintain a regular schedule of meals, sleep and exercise.
4. Learn to count – It is easy to focus on all that is wrong in the world. And there is much to be stressful about. It takes effort to focus on what is going well and to count your blessings. Doing this helps your focus on what is good in your life.

If symptoms become severe and affect daily living, there are a number of treatments available. There are medications which can help with the mood, sleep and other symptoms of anxiety and depression. Taking medications for seniors can be difficult as they may already be on a number of chronic medications for their existing health conditions. They are also more vulnerable due to their age. However, with careful titration of appropriate medications, many seniors have responded well to such medications.

There are also psychosocial interventions (e.g. “talk” therapies) which have been found to be useful in alleviating the symptoms of loneliness, anxiety and depression as well as teaching life skills on how to keep well and maintain good relationships with friends and family. Whilst some of the therapies may be difficult for the seniors for a variety of reasons (e.g. language barriers), certain therapies can still be tailored to help.

 

Dr Mok Yee Ming is a senior consultant and head of the Department of Mood and Anxiety at the Institute of Mental Health (IMH).

 

(** PHOTO CREDIT: Unsplash/Joseph Chan)

 

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